Home care challenge: retaining workers, keeping costs low

Debbie Hardy of Ansonia, an independent home health care aide, cares for Frank Geraldino in his Seymour apartment. Photos by Tony Bacewicz.

Debbie Hardy, a home health care aide, is the reason that Frank Geraldino, 48, a paraplegic, is able to live in his Seymour apartment - rather than in a nursing facility.

Hardy, of Ansonia, is an independent worker providing in-home personal care services, such as bathing and feeding, for people with serious disability. Medicaid covers the bill, but the patients are technically the employers, hiring and scheduling their own in-home care.

More than 6,000 personal care workers are listed on various registries as providing in-home care services. The lists include home health aides, who are trained and licensed as certified nursing assistants, and personal care assistants, who are not licensed.

The state projects a need for another 9,000 to 10,000 of these workers in the next four years as Connecticut attempts to cut skyrocketing Medicaid costs by moving people from health care facilities back to their homes.

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The state received a $56 million Money Follows the Person federal grant to support the policy change. Community care is about a quarter of the cost of institutional care, according to the National Council on Disability. So far 1,636 people have transitioned from health care institutions to in-home care under the program. The long-term goal is to transition 5,000 residents by 2016.

The state last year passed a law allowing these independent care workers to unionize. They are now paid an average of $11.55 an hour and receive no benefits.

"You have to have a heart to do this type of work, because there really is no money in it," said Hardy.

Workers like Hardy would be more likely to stay in the field if it paid better and provided benefits, said Deborah Chernoff, of the New England Health Care Employees Union (NEHCEU). When NEHCEU surveyed workers, their top three priorities (in order) were health benefits, paid sick time and increased hours.

Any contract would need to be negotiated with the state and approved by the General Assembly. Negotiations have not yet begun.

State House Speaker Brendan Sharkey, D- Hamden, supported giving home care workers collective bargaining rights, in hopes that better compensation would raise standards in the profession. He was frustrated when he tried to hire people to help him care for his own mother. "They turned out to be completely unskilled ... really not equipped to take care of someone who had experienced signs of dementia," Sharkey said.

Workers pledged to use a contract to raise the standards of their profession. Chernoff said that she could envision a basic level of training that would allow people to go on for additional qualifications in areas like dementia or behavioral health. "There are lots of possibilities that would give people some specialized training," she said.

Yet Chernoff admits that getting a contract through the legislature will be difficult as the state faces a budget deficit.

Sharkey said it is important to balance increased costs for home care workers with greater savings achieved by moving people out of institutions. "This is an area where I think the state can be pennywise and pound-foolish," he said.

Catherine Ludlum, a Manchester resident who has used aides for 25 years, opposed unionization. "The state is bankrupt, in case people hadn't noticed," said Ludlum. She worries that a rise in compensation might lead to a cutback in services. Ludlum does not believe that pay is a barrier to recruiting workers. "Lot's of places are paying minimum wage (for) doing work that's less rewarding," she said.

Most patients enjoy a better quality of life when they leave institutional care, according to a recent University of Connecticut report on Money Follows the Person.

That's been true for Geraldino. "I didn't like the nursing home. I was the only young one there," he said.

Geraldino's life changed suddenly 10 years ago, when the lineman fell 45 feet to the ground from a telephone pole. "That's what they tell me. I don't remember," said Geraldino.

Geraldino spends his time in bed, where he watches television, surfs the Internet and listens to the rock 'n roll he loves. His tiny unit is filled with trophies and team pictures, including the 1980 Seymour Wildcats, state champions in football. Geraldino played defensive end and safety.

As Hardy bustled around his apartment to fix breakfast and shave Geraldino, the two joked and made small talk. "I'm close with all (my aides). They take good care of me," he said.

Hardy, however, recently left Geraldino's employ, only to return after he'd had some health setbacks.

She worries about hurting her back as she cares for Geraldino. She'd have no coverage for injury. "You work and you get hurt - too bad, so sad," she said.

Geraldino relies on a team of workers who coordinate with each other. They can work for a single client for 25.75 hours per week, or the client would need to pay for worker's compensation insurance.

Turnover in workers is a major problem, according to Elizabeth Rosa, an organizer at the Naugatuck Valley Project, who is studying home care for elderly immigrants.

"The elderly complain about constant changes," she said. Most want Spanish-speaking workers but have trouble hanging onto them, Rosa said. Workers, she added, complain about the price of gas and parking eating away their paychecks. Because they cannot work full-time for a single patient, many drive from home to home, using their own cars.

Workers and clients often grow close. Hardy brings over food to supplement what Geraldino gets from the food bank.

"I love taking care of people," she said. But the balance between how hard she works and how much she's paid needs to shift, Hardy added. "When I get home," she said, "all I want to do is sleep."

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).